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Frequently Asked Dental Questions

Are silver fillings, fluoride, or x-rays a danger to my health? What are the alternatives?

Let me say first of all that the best dentistry is NO dentistry!! Perfection is a tooth without decay or disease. The best we know how to restore them is, at best, a distant second compared to God’s handiwork. So, we focus on prevention with regular maintenance appointments, dietary and supplement coaching, and particular attention to homecare regimens that are proven in the literature.

When we must restore teeth, we use the longest-lasting, most biocompatible restorative materials currently known to the profession. “Amalgam,” by definition, is a mixture of a metal with mercury.

Silver amalgam is a common restorative material in dental practices in the U.S. We don’t feel that mercury is a good idea in anyone’s mouth. The literature gave me enough concern about mercury in fillings that I chose to discontinue its use in 1999. We simply don’t offer it in this practice, because we don’t see it as a healthy service. In addition, silver amalgam has very low crushing strength, so after a few years, it begins to expand in the center of the tooth and ultimately causes cracks in the surrounding tooth structure resulting in broken, cracked, and sensitive teeth.

Fluoride is judiciously used topically with people that seem to be caries-prone. Sometimes people can become more caries-prone when taking certain medications that dry the mouth. Dietary habits with hidden sugars can also cause decay. We do not advocate the systemic use of fluoride, simply because it is a VERY active ion and attaches to many chemical reactions in the body that may not necessarily be beneficial to your systemic health.

X-rays are a necessary modality to see disease processes within the teeth, in bone and beneath the surface of the gums. We are acutely aware of people’s concerns about radiation. For that reason, we made a considerable capital investment to convert to all-digital x-ray equipment, thereby reducing radiation exposure 85%-90%. The use of digital radiography also has a positive environmental impact, as we no longer require the use of darkroom chemicals to process film.

My gums bleed after I brush. If my gums bleed when I brush, is that considered normal?

Would you think it was normal for your hands to bleed when you washed them? Of course not!! If the gums are bleeding, they need some personal and professional help to grow new skin back on them. That way, the skin keeps the blood in and the bacteria out!! Our dental hygiene department’s goal in life is to have their patients in the maximum health and comfort that is personally attainable. The key is to teach patients how to maintain that level with a personalized program of homecare and regular professional maintenance.

I really do not like visiting the dentist. Is there anything you can do to help me relax?

Please visit the sedation section of our website.

I want my front teeth to look better but I do not want to wear braces. What would you recommend?

It all depends. For teeth that are structurally sound without many old fillings, Invisalign is an excellent alternative to metal braces if significant crowding is the issue. If the teeth are extensively filled, then all porcelain veneers or crowns are a means for an instant “makeover.” A consultation would be in order to examine alternatives that suit your unique circumstances.

What is Invisalign?

Invisalign is an esthetic orthodontic technique that corrects malocclusion using a series of custom-made, computer-generated, nearly invisible, comfortable, and removable Aligners. It is particularly suitable for adults who need or want orthodontics, but do not want to wear the traditional metal “braces.” We find it beneficial to achieve minor corrections before doing an esthetic case, as it can enhance the results significantly. The aligners must be worn 22 hours a day, and some cases may not be suitable for their use, due to the length of time required versus conventional treatment. Best way to see if you are a candidate is to be examined first by a dentist who is a certified Invisalign provider.

How does Dr. St. Clair keep up to date with all the current techniques and materials?

The state of Massachusetts requires 40 hours of continuing education per two-year licensure renewal period for dentists. Dr. St. Clair belongs to two professional study clubs, at least 4 or more professional organizations and averages 75-100 hours per year in continuing education, both in lecture and hands-on formats. He has invested hundreds of thousands of dollars on education after dental school.

Do you accept referrals?

We are almost exclusively a referral practice, built upon the kind referrals of our existing clients. If you have read this far into this website, you are merely a stranger who is not a friend yet!

Why is my occlusion so important, and just what is occlusion, anyway?

Ever had a raspberry seed stuck in your teeth? It might as well have been a boulder, right? Occlusion has to do with the way the teeth fit. If the teeth fit, but the muscles that support the jaw are not happy in that position, the result can be headaches, neck aches, TMJ (jaw joint) problems, broken or severely worn teeth, receding gums, or loosening of the teeth. The reason occlusion is so important is if the teeth, bones, joints, and muscles are in harmony, the “permanence” or longevity of required dental restorations is highly predictable.

I read somewhere that headaches can be related to my bite. Is that true?

The matrix of muscles that surround the jaw joints and lower jaw also attach to the skull, neck or cervical spine, and the shoulder girdle or what physical therapists call the upper quadrant. There are also peripheral muscles relating to swallowing and head posture that, when stressed by poor bite or occlusion, can be in low grade spasm that ultimately results in headaches.

I experience noises in my jaw joints. Should I be concerned?

Definitely! Pops, clicks, and grinding or sandy-sounding noises mean there is something going on in the joint that is not normal. It usually indicates disharmony between the muscles of mastication and the way the teeth fit, resulting in stretching or tearing of the supporting cartilage and ligaments in the TMJ itself. If these signs and symptoms are accompanied by pain, better have it checked out--quick!!

Do you accept my insurance plan?

Dr. St .Clair currently accepts Delta Dental, Blue Cross/Blue Shield and just about any other insurance where you do not have to pick a dentist from a list. Remember, insurance companies’ first goal is making a profit for their shareholders, and secondarily helping you with your dental needs! Dentists who belong to low-cost HMO/PPO dental plans have to cut costs somewhere – take a guess where that is.

Click below to read newspaper columns Dr. St. Clair has written on dental insurance.

What do I do if I have an emergency when the office is closed?

Dr. St. Clair can always be reached on his cell phone (978) 771-2638. If Dr. St. Clair is away for any reason, a doctor on call, whom he knows personally, will be available.

I have a temporary crown in my mouth. What happens if it comes off or breaks?

If the temporary comes off, it is rather important to get it back on in order to hold the proper relationship for the new restoration. There is a commercial product available in pharmacies, called DenTemp that can be used in an emergency. Also, in a pinch, a little denture adhesive will hold the cap on for several days. If the temporary breaks and there are no symptoms with the tooth, it should be re-made and re-cemented on the next business day, if possible. If the tooth is uncomfortable, call Dr. St. Clair on his cell phone (978) 771-2638.

What different payment options do you provide?

Please see the financial section of our website.

How can I ask Dr. St. Clair questions directly?

Dr. St. Clair will make timely responses by e-mail or phone. His e-mail address is jpstclair@stclairdmd.com. If you need to consult with him regarding treatment options that you are considering, please call the office to schedule a no-charge second opinion visit.

I don’t like drills. Are there any other options?

Your other options, which are not currently available in this practice, are air-abrasion technology or hard-tissue laser. These are not available in our office because, after careful research at this point in time, there is not significant time savings for the patient to warrant the capital investment required. We feel dental patients don’t want to be in the office any longer than is absolutely necessary, so we are able to perform these services in less elapsed time with conventional means at this moment.

How do I know when it is time for a checkup?

Most adults require bi-annual to quarterly visits to maintain optimum periodontal health and longevity. We tailor our re-care visits to your unique conditions.

Do I have to floss every day? Is it really important?

You don’t have to floss all your teeth, just the ones you want to keep!

What precautions do you take to ensure patient safety?

We use heat sterilization and disposable barriers on everything that comes into contact with patients in the treatment environment. We use protective eyewear all around. In addition, we use high power magnification to provide better vision and precision to dental procedures.

What about my children? At what age should they see a dentist? What’s your philosophy on treating children?

We love kids! Unless a parent sees something unusual, we recommend seeing children at the age of 3 for the first time. If treatment is needed that is beyond the scope of our practice, a referral will be given to a pediatric dentist. We rarely find the need to refer kids.

I’m taking my child to a pediatric dentist. When do we make the change back to a general practice?

I like to see kids switch around the age of 10 or so because I like to be a part of the decision-making process of orthodontics.

What’s your philosophy about orthodontics?

Early interceptive treatment and finish by age 13! Why by age 13? Age 13 is the benchmark, especially for girls, when they become VERY social. After that, social stuff is a whole lot more important than cooperating with the orthodontist to finalize a perfect case. I do offer one particular service that is FREE for children that may be the most important service I can offer. Since I treat lots of TMJ disorders, I am in a unique position to see early developing TMJ problems in children. If I can see your child when they have their four upper and lower permanent incisors in position (age 5½ to 7½), many times we can identify early developing TMJ problems that can be solved by early interceptive treatment by one of our network of astute orthodontists. Early interceptive orthodontics is one of the BEST possible services for a child. Early treatment when a child is growing solves a myriad of problems later. (This area of orthodontics is called facial orthopedics.) The results are beautiful faces, healthy jaw joints, perfect occlusions, and very few TMJ-related headaches as an adult.

What if I need to cancel an appointment?

Out of respect for the doctor’s time and our other patients’ time, we ask that you make every effort to give us at least 48 hours notice, particularly if you have reserved a large block of time for major treatment. We are, however, cognizant that it is not always possible, and family or personal emergencies do occur. Please leave a message on our message center, or if it is less than 24 hours notice, call the doctor’s emergency line, so we are able to give your time to someone who can use it.

Is it possible to whiten my teeth too much?

While there is nothing in the literature to indicate that this is a problem, we need to remember that all things in moderation is a good thing. There comes a point with anyone’s teeth where all the product in the world will not make them whiter. Whitening became popular in the 80’s, and so far, there is no study to indicate that there is harm. Using whitening gel on a monthly basis is not required, in our estimation.

What about tetracycline stain? Will it respond to whitening?

It all depends. I have seen some cases respond to whitening, but it will take longer and require the use of particular products and protocols to accomplish it.

How do I make a decision about cosmetic or esthetic dentistry?

We feel that decision is best made in consultation with a highly trained dentist who is familiar with, and has extensively trained for this type of dentistry. Functional dentistry, properly done, is also very cosmetic or esthetic. We are finding that esthetic desires vary widely from patient to patient. Nearly 50% of our post-graduate education is spent in learning more about esthetic dentistry. Esthetic dentistry also requires world-class laboratory support. Ultimately, do you want people to look at you and say: “You look terrific — what did you do for yourself?” Or: “Nice caps!!”?

How did you choose dentistry as a career?

I grew up in both Long Island and Connecticut. My father, still a practicing veterinarian with my brother, used to take me to his office every weekend. Being the oldest of three, my job was to clean-out dog cages. I think that is the reason I am not a veterinarian today. I do have two dogs though.

My parents were big on education. I went to private school just about my whole life….could be why my kids are in public school. Anyway, I got a terrific high school education at a boarding school called Avon Old Farms, which I did not fully appreciate until later in life. If you have not heard of or seen the architecture of this school, you should check out the website www.avonoldfarms.com. From there I went to St. Anselm College in Manchester New Hampshire, my father’s alma-mater. I loved science and decided to be a biology major. I played on the golf team my first year but quickly realized I couldn’t do both……and there was no chance of me becoming a golf pro. For two years during the summers, I landed a great internship at Bristol Myers-Squibb. I learned a lot including that I didn’t want to do research my whole life. As I approached my senior year, I realized that college was going to be coming to an end and I had to choose something to do with my life. I instantly thought medicine. I worked nights at a local emergency room and loved it. However, I wasn’t sure that I wanted the hours that I saw many physicians had. My girlfriend’s (now my wife) mother at the time brought up dentistry. I thought – teeth? – that’s like looking at feet all day. I looked into it and decided to apply. The first school I got into was Tufts and I decided to go. So, no, I did not want to be a dentist my whole life. It was a last minute decision. I love what I do. Every once in a while I think about what it would be like doing something else. If I could do it all over again I would still be a dentist.

I like medicine, so I’m curious about my patients’ total health, as the mouth is often the indicator of their general health. I read a lot of medical/dental type stuff. It’s been my privilege to render early diagnoses of and qualified referrals for a number of my patients, intercepting some significant medical conditions. In doing my research, I’ve discovered it’s a whole lot easier to stay well, than it is to get well!! So you’ll find we stress prevention and personal responsibility a lot in this practice. Over the years, I’ve found there is nothing I can do, no service I can perform, no material I can use, no high tech gadget I can employ, that will overcome what a patient will NOT do with diet and home care. On top of that, medicine and dentistry as they are currently practiced are far more attuned to treating illness and disease than reversing or curing it. That, unfortunately, is the unhappy truth.